AB0448 ADVERSE PREGNANCY OUTCOMES IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: THE ROLE OF THERAPY.
Authors: M. B. Cilona, V. Canti, I. Dalpiaz, R. De Lorenzo, G. Inguscio, C. Asperti, S. Rosa, M. T. Castiglioni, P. Rovere-Querini
Journal: Annals of the Rheumatic Diseases (2022)

Background Our study supports that treatment with glucocorticoids at medium-high doses during pregnancy adversely affects pregnancy outcome with an increased risk of both APO and birth of SGA infants. These data can be related to a direct role of the drug in determining maternal-fetal outcome and to the presence of an incomplete control over disease activity. The comparison between pregnancies followed before 2010 and since 2010 conducted in our study shows that the introduction of drugs such as hydroxychloroquine and azathioprine from the beginning of the pregnancy can reduces the frequency of APO in general. These medications could represent a safety therapeutic strategy both for the mother and for the fetus in order to control autoimmune disease during pregnancy and minimize the occurrence of complications. Further studies on larger numbers of placenta in APS patients will be needed to confirm our findings. Objectives To investigate whether treatment in SLE patients during pregnancy may influence the occurrence of APO events and, in particular, the birth of SGA infants. Methods We performed a monocentric observational study in SLE pregnant patients prospectively followed at the ‘Pregnancy at risk’ multidisciplinary outpatient clinics at San Raffaele Hospital, Milan, Italy from January 2003 to June 2021. We collected data from 79 pregnancies in 58 patients with a diagnosis of SLE. Results 13/79 (16%) pregnancies ended in a spontaneous abortion. In the other 66/79 (84%) APOs occurred in 29/66 (44%) pregnancies. 17 of the 66 (26%) pregnancies that did not end in spontaneous abortion ended with the birth of SGA infants. Glucocorticoid treatment at medium-high doses (e.i. prednisone ≥ 5 mg) was associated to an increased risk for APO (OR 4.431, p-value 0.018) and for the birth of SGA infants (OR 4.401, p-value 0.019). Preterm delivery (7/43, 16% versus 7/23, 30%), hypertension and/or preeclampsia (4/43, 9% versus 5/23, 22%) were observed with low incidence in pregnancy followed since 2010 than before 2010, even if without reaching statistical significance. Conclusion Our study supports that treatment with glucocorticoids at medium-high doses during pregnancy adversely affects pregnancy outcome with an increased risk of both APO and birth of SGA infants. These data can be related to a direct role of the drug in determining maternal-fetal outcome and to the presence of an incomplete control over disease activity. The comparison between pregnancies followed before 2010 and since 2010 conducted in our study shows that the introduction of drugs such as hydroxychloroquine and azathioprine from the beginning of the pregnancy can reduces the frequency of APO in general. These medications could represent a safety therapeutic strategy both for the mother and for the fetus in order to control autoimmune disease during pregnancy and minimize the occurrence of complications. Further studies on larger numbers of placenta in APS patients will be needed to confirm our findings. References [1]Moroni, G. &amp; Ponticelli, C. Pregnancy in women with systemic lupus erythematosus (SLE). Eur. J. Intern. Med. 32, 7–12 (2016). [2]Palmsten, K., Simard, J. F., Chambers, C. D. &amp; Arkema, E. V. Medication use among pregnant women with systemic lupus erythematosus and general population comparators. Rheumatol. (United Kingdom) 56, 561–569 (2017). Disclosure of Interests None declared